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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: COOK INC BEACON TIP TORCON NB ADVANTAGE ANGIOGRAPHIC CATHETER; DQO CATHETER, INTRAVASCULAR, DIAGNOSTIC

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COOK INC BEACON TIP TORCON NB ADVANTAGE ANGIOGRAPHIC CATHETER; DQO CATHETER, INTRAVASCULAR, DIAGNOSTIC Back to Search Results
Model Number G09751
Device Problem Break (1069)
Patient Problem Foreign Body In Patient (2687)
Event Date 07/14/2022
Event Type  Injury  
Event Description
As reported, upon successful completion of a fistula de-clotting procedure in the upper arm, the tip of a beacon tip torcon nb advantage angiographic catheter separated and remains in the patient.Per the user, the vessel is too small to retrieve the device, which reportedly will be unable to migrate due to the small size of the vessel.The patient did not require any additional procedures due to this occurrence.According to the initial reporter, the patient did not experience any adverse effects due to this occurrence.
 
Manufacturer Narrative
Blank fields on this form indicate the information is unknown or unavailable.This report includes information known at this time.A follow-up report will be submitted should additional relevant information become available.This report is required by the fda under 21 cfr part 803 and is based on unconfirmed information submitted by others.Neither the submission of this report nor any statement contained herein is intended to be an admission that any cook device is defective or malfunctioned, that a death or serious injury occurred, nor that any cook device caused, contributed to, or is likely to cause or contribute to a death or serious injury if a malfunction occurred.
 
Event Description
No additional information regarding the patient or event has been received since the last medwatch report was submitted.
 
Manufacturer Narrative
Blank fields on this form indicate the information is unknown, unchanged, or unavailable.Summary of event: as reported, upon successful completion of a fistula de-clotting procedure in the upper arm, the tip of a beacon tip torcon nb advantage angiographic catheter separated and remains in the patient.Per the user, the vessel is too small to retrieve the device, which reportedly will be unable to migrate due to the small size of the vessel.The patient did not require any additional procedures due to this occurrence.According to the initial reporter, the patient did not experience any adverse effects due to this occurrence.Investigation evaluation: reviews of the complaint history, device history record, instructions for use (ifu), manufacturing instructions, and quality control procedures were conducted during the investigation.A visual inspection of the complaint device was also conducted.The complaint device was returned for investigation.The distal tip of the catheter was missing.The length of the remaining catheter was 38.2 centimeters.A document-based investigation evaluation was performed.No related non-conformances were found, and there have been no other reported complaints for this lot number.The product ifu states that manipulation requires fluoroscopic control and instructs to stop and determine the cause of resistance, if encountered, before proceeding.The information provided upon review of the dmr, dhr, ifu, and investigation of the returned device suggests that there is evidence the device was manufactured to specification.There is no evidence of non-conforming devices in-house or in the field.Cook has concluded that sufficient inspection activities are in place to identify this failure mode prior to distribution.Based on the information provided and the results of the investigation, cook has concluded that a component failure contributed to this event.The risk analysis for this failure mode was reviewed and no additional escalation was required.The appropriate personnel have been notified and cook will continue to monitor for similar events.This report is required by the fda under 21 cfr part 803 and is based on unconfirmed information submitted by others.Neither the submission of this report nor any statement contained herein is intended to be an admission that any cook device is defective or malfunctioned, that a death or serious injury occurred, nor that any cook device caused, contributed to, or is likely to cause or contribute to a death or serious injury if a malfunction occurred.
 
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Brand Name
BEACON TIP TORCON NB ADVANTAGE ANGIOGRAPHIC CATHETER
Type of Device
DQO CATHETER, INTRAVASCULAR, DIAGNOSTIC
Manufacturer (Section D)
COOK INC
750 daniels way
bloomington IN 47404
Manufacturer (Section G)
COOK INC
750 daniels way
bloomington IN 47404
Manufacturer Contact
jason crouch
750 daniels way
bloomington, IN 47404
8123392235
MDR Report Key15085921
MDR Text Key296405553
Report Number1820334-2022-01259
Device Sequence Number1
Product Code DQO
UDI-Device Identifier00827002097513
UDI-Public(01)00827002097513(17)240602(10)14768550
Combination Product (y/n)N
Reporter Country CodeUS
PMA/PMN Number
K173289
Number of Events Reported1
Summary Report (Y/N)N
Report Source Manufacturer
Source Type User Facility,Company Representative
Reporter Occupation Other
Type of Report Initial,Followup
Report Date 11/18/2022
1 Device was Involved in the Event
1 Patient was Involved in the Event
Is this an Adverse Event Report? Yes
Is this a Product Problem Report? Yes
Device Operator Health Professional
Device Expiration Date06/02/2024
Device Model NumberG09751
Device Catalogue NumberHNBR5.0-35-40-P-NS-KMP
Device Lot Number14768550
Was Device Available for Evaluation? Device Returned to Manufacturer
Is the Reporter a Health Professional? No
Initial Date Manufacturer Received 07/14/2022
Initial Date FDA Received07/22/2022
Supplement Dates Manufacturer Received11/03/2022
Supplement Dates FDA Received11/18/2022
Was Device Evaluated by Manufacturer? Yes
Date Device Manufactured06/02/2022
Is the Device Single Use? Yes
Is This a Reprocessed and Reused Single-Use Device? No
Type of Device Usage Initial
Patient Sequence Number1
Patient Outcome(s) Other;
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